State program leaves poorest kids short of dental care

California’s dental program for low-income children is leaving many of the kids it is intended to serve at high risk of developing lifelong dental diseases because it has failed to provide adequate services, a state audit released Thursday has found.

The 92-page report described a system that serves fewer than half the children enrolled in the program, attributing that mainly to a lack of dentists willing to accept the rates the state is willing to pay them for their services. Those rates, which haven’t increased since 2000, were cut by 10 percent last year.

Problems with the program, known as Denti-Cal, have persisted for years, but health advocates worry that the migration last year of more than 865,000 kids into Medi-Cal from the state’s Healthy Families program under the federal health law will make matters worse. More than 5.1 million children are now covered by Medi-Cal, the state health program for the poor.

“While the state has taken some steps to increase the number of children in Medi-Cal who get needed dental care, more needs to be done, and this audit clearly demonstrates that,” said Jenny Kattlove, director of strategic health initiatives for the Children’s Partnership, an advocacy group that pushed for the audit.

The state’s report found that the state as a whole appeared to have enough dentists in its Denti-Cal program, but that access to them varied by geography. As of January 2014, the state found, as many as five of California’s 58 counties may not have a single dentist who accepts Denti-Cal. In addition, dentists in 11 counties weren’t willing to accept new patients and 16 counties had an inadequate number of dental providers in the program.

The problem is worse in rural and far Northern California counties than in urban areas like San Francisco. The report ranked counties such as Alpine, Amador, Del Norte, Sierra, Inyo and Mono the lowest in terms of access to Denti-Cal services for kids.

The report criticized the California Department of Health Care Services for failing “to adequately monitor the program” and comply with state law that requires it to review the reimbursement rates each year to ensure that Medi-Cal recipients have reasonable access to services.

The auditor also chided the department for not enforcing terms with Delta Dental of California, the private company the state contracts with to provide services, that required it to make sure that at least mobile services were available in underserved areas.

Delta Dental, located in San Francisco and the state’s largest dental insurer, declined to comment.

The auditor recommended a series of changes for improvement, and the Department of Health Care Services agreed to all of them except one because it says it’s not required by state law, agency officials said. The agency said in a statement that it will provide updates to the auditor throughout the year.

“The department is committed to ensuring that all of our beneficiaries in California have appropriate access to high-quality care,” the department said.

Despite the dismal findings, health advocates were encouraged by the report.

“Dental has finally been getting the attention it needs,” said Eileen Espejo, director of media and health policy for Children Now, an advocacy group in Oakland. “Reports like these are really saying we can’t be silent anymore. If a child is in pain, they’re not concentrating on lessons going on in school. We know the mouth cannot be separated from the body.”